Aortoiliac stent deployment versus surgical reconstruction: Analysis of outcome and cost

Abstract

Treatment of severe aortoiliac occlusive disease by surgical reconstruction or stent deployment has a similar complication rate. Mean hospital cost per limb treated is essentially equal. However, cumulative primary patency rate of bypass grafts is superior to stents. Therefore, considering the elements of cost and patency, surgical revascularization has greater value. The benchmark for cost-effective treatment of severe aortoiliac occlusive disease is direct surgical reconstruction.

A Call to Action: Women and Peripheral Artery Disease

“…63,132,221,278 In their analysis of patients with aortoiliac occlusive disease treated with a combination of surgical and endovascular techniques, Ballard and colleagues 221 found a relative risk of 4.6 for bypass or stent thrombosis in women. Green et al 143 observed a gender-specific relationship between graft size and thrombosis among patients treated with prosthetic aboveknee femoropopliteal bypass; 5-year cumulative patency rates in that report were 69.1% versus 37.9% for men with large versus small grafts and 45% for women in both graft-size categories.…”

Aortoiliac Occlusive Disease

“…(46) The graft patency rates continues to improve and the accumulated experience to date has shown that 5-year primary patency rates between 85% and 90% and 10-year rates between 75% and 85% can be expected with aortobifemoral grafting Similarly the perioperative mortality rate continues to decline and less than 2% mortality is a standard now. (47,48) Age has proved to be a significant predictor of outcome; in one report, primary patency rates at 5 years were greater than 95% for patients older than 60 years but only 66% for those younger than 50 years. (49)…”

“…For patients undergoing aortobifemoral grafting, postoperative hemorrhage is a relatively rare event, occurring in 1% to 2% of cases. (37,47) Careful postoperative monitoring of the abdominal girth, hematocrit, bladder pressure, coagulation parameters, and hemodynamic status is paramount to identify ongoing bleeding significant enough to require urgent reoperation.…”

Minimal invasive und simultan offene und endovaskuläre Gefäßeingriffe

“…Um den Anforderungen gerecht zu werden, benötigen wir flexible Trainingsprogramme, interventionelle Trainingsprogramme und eine adäquate Vergütung der medizinischen und ärztlichen Leistungen für die Behandlung der meist komplex erkrankten Gefäßpatienten [6]. In Zukunft könnten wohl auch betriebswirtschaftliche Gründe eine Rolle bei der Entscheidung über die Anwendung der unterschiedlichen Therapieverfahren spielen [4,16] Simultane intraoperative endovaskuläre Therapieverfahren im Rahmen einer offenen Gefäßrevaskularisation 1997 1998 1999 2000 2001 Total Iliakal 9 16 14 17 29 85 Femoral 16 32 13 17 18 96 Popliteal 7 10 2 4 6 29 Krural 5 18 5 5 6 Klinische Ergebnisse. Klinische Studien zeigen eine signifikante Reduktion der Wundkomplikationen sowohl in der peripheren Bypasschirurgie von 24% auf 8% (retrospektive Studie [18]) als auch in einer prospektiven Studie in der Koronarchirurgie von 22% auf 6% [30].…”